The typical presentation of an atypical pathogen during an outbreak of Legionnaires' disease in Vila Franca de Xira, Portugal, 2014

A Dias, A. Cysneiros, F T Lopes, B von Amann, C Costa, P Dionísio, J Carvalho, V Durão, G Carvalho, Filipe S. Paula, M Serrado, B Nunes, T. Marques, F. Froes, Cristina Bárbara

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Abstract

BACKGROUND: An outbreak of Legionella pneumophila serogroup 1, with 403 cases was identified on the 7th November 2014 in Vila Franca de Xira, Portugal. Outbreak source was the wet cooling system of a local factory. Hospital Pulido Valente was one of the hospitals receiving patients with Legionnaires' disease (LD).

METHODS: We describe the clinical findings and diagnostic methods used among the 43 confirmed or probable cases admitted to our department.

RESULTS: 60.5% were male, mean age was 56.1±13.5 years and tobacco smoking was the most frequent risk factor (76.7%). All patients had fever, 62.8% ≥39.5°C, 72.1% had chills and myalgia/arthralgia and 62.8% had dry cough. Extra pulmonary symptoms were frequent: confusion and headache occurred in 34.9% and gastrointestinal symptoms in 20.9%. High C-Reactive Protein (55.8% ≥30mg/dL) and hyponatremia (62.8%) were the laboratorial abnormalities most commonly found. Hypoxemia occurred in 55.8% and hypocapnia in 93%. Urinary Antigen Test (UAT) was positive in 83.7% of the cases.

CONCLUSIONS: Although not specific, a combination of risk factors, symptoms and laboratory findings can be highly suggestive of LD, even in an outbreak. This should prompt diagnosis confirmation. Routine use of UAT in less severe cases of community acquired pneumonia might contribute to earlier diagnosis.

Original languageEnglish
Pages (from-to)117-123
Number of pages7
JournalRevista Portuguesa de Pneumologia
Volume23
Issue number3
DOIs
Publication statusPublished - 6 Mar 2017

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Legionnaires' Disease
Portugal
Disease Outbreaks
Hypocapnia
Antigens
Legionella pneumophila
Confusion
Chills
Hyponatremia
Myalgia
Arthralgia
Cough
C-Reactive Protein
Headache
Early Diagnosis
Pneumonia
Fever
Smoking
Lung

Keywords

  • Journal Article

Cite this

Dias, A ; Cysneiros, A. ; Lopes, F T ; von Amann, B ; Costa, C ; Dionísio, P ; Carvalho, J ; Durão, V ; Carvalho, G ; Paula, Filipe S. ; Serrado, M ; Nunes, B ; Marques, T. ; Froes, F. ; Bárbara, Cristina. / The typical presentation of an atypical pathogen during an outbreak of Legionnaires' disease in Vila Franca de Xira, Portugal, 2014. In: Revista Portuguesa de Pneumologia. 2017 ; Vol. 23, No. 3. pp. 117-123.
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title = "The typical presentation of an atypical pathogen during an outbreak of Legionnaires' disease in Vila Franca de Xira, Portugal, 2014",
abstract = "BACKGROUND: An outbreak of Legionella pneumophila serogroup 1, with 403 cases was identified on the 7th November 2014 in Vila Franca de Xira, Portugal. Outbreak source was the wet cooling system of a local factory. Hospital Pulido Valente was one of the hospitals receiving patients with Legionnaires' disease (LD).METHODS: We describe the clinical findings and diagnostic methods used among the 43 confirmed or probable cases admitted to our department.RESULTS: 60.5{\%} were male, mean age was 56.1±13.5 years and tobacco smoking was the most frequent risk factor (76.7{\%}). All patients had fever, 62.8{\%} ≥39.5°C, 72.1{\%} had chills and myalgia/arthralgia and 62.8{\%} had dry cough. Extra pulmonary symptoms were frequent: confusion and headache occurred in 34.9{\%} and gastrointestinal symptoms in 20.9{\%}. High C-Reactive Protein (55.8{\%} ≥30mg/dL) and hyponatremia (62.8{\%}) were the laboratorial abnormalities most commonly found. Hypoxemia occurred in 55.8{\%} and hypocapnia in 93{\%}. Urinary Antigen Test (UAT) was positive in 83.7{\%} of the cases.CONCLUSIONS: Although not specific, a combination of risk factors, symptoms and laboratory findings can be highly suggestive of LD, even in an outbreak. This should prompt diagnosis confirmation. Routine use of UAT in less severe cases of community acquired pneumonia might contribute to earlier diagnosis.",
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Dias, A, Cysneiros, A, Lopes, FT, von Amann, B, Costa, C, Dionísio, P, Carvalho, J, Durão, V, Carvalho, G, Paula, FS, Serrado, M, Nunes, B, Marques, T, Froes, F & Bárbara, C 2017, 'The typical presentation of an atypical pathogen during an outbreak of Legionnaires' disease in Vila Franca de Xira, Portugal, 2014', Revista Portuguesa de Pneumologia, vol. 23, no. 3, pp. 117-123. https://doi.org/10.1016/j.rppnen.2017.01.007

The typical presentation of an atypical pathogen during an outbreak of Legionnaires' disease in Vila Franca de Xira, Portugal, 2014. / Dias, A; Cysneiros, A.; Lopes, F T; von Amann, B; Costa, C; Dionísio, P; Carvalho, J; Durão, V; Carvalho, G; Paula, Filipe S.; Serrado, M; Nunes, B; Marques, T.; Froes, F.; Bárbara, Cristina.

In: Revista Portuguesa de Pneumologia, Vol. 23, No. 3, 06.03.2017, p. 117-123.

Research output: Contribution to journalArticle

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T1 - The typical presentation of an atypical pathogen during an outbreak of Legionnaires' disease in Vila Franca de Xira, Portugal, 2014

AU - Dias, A

AU - Cysneiros, A.

AU - Lopes, F T

AU - von Amann, B

AU - Costa, C

AU - Dionísio, P

AU - Carvalho, J

AU - Durão, V

AU - Carvalho, G

AU - Paula, Filipe S.

AU - Serrado, M

AU - Nunes, B

AU - Marques, T.

AU - Froes, F.

AU - Bárbara, Cristina

N1 - Copyright © 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

PY - 2017/3/6

Y1 - 2017/3/6

N2 - BACKGROUND: An outbreak of Legionella pneumophila serogroup 1, with 403 cases was identified on the 7th November 2014 in Vila Franca de Xira, Portugal. Outbreak source was the wet cooling system of a local factory. Hospital Pulido Valente was one of the hospitals receiving patients with Legionnaires' disease (LD).METHODS: We describe the clinical findings and diagnostic methods used among the 43 confirmed or probable cases admitted to our department.RESULTS: 60.5% were male, mean age was 56.1±13.5 years and tobacco smoking was the most frequent risk factor (76.7%). All patients had fever, 62.8% ≥39.5°C, 72.1% had chills and myalgia/arthralgia and 62.8% had dry cough. Extra pulmonary symptoms were frequent: confusion and headache occurred in 34.9% and gastrointestinal symptoms in 20.9%. High C-Reactive Protein (55.8% ≥30mg/dL) and hyponatremia (62.8%) were the laboratorial abnormalities most commonly found. Hypoxemia occurred in 55.8% and hypocapnia in 93%. Urinary Antigen Test (UAT) was positive in 83.7% of the cases.CONCLUSIONS: Although not specific, a combination of risk factors, symptoms and laboratory findings can be highly suggestive of LD, even in an outbreak. This should prompt diagnosis confirmation. Routine use of UAT in less severe cases of community acquired pneumonia might contribute to earlier diagnosis.

AB - BACKGROUND: An outbreak of Legionella pneumophila serogroup 1, with 403 cases was identified on the 7th November 2014 in Vila Franca de Xira, Portugal. Outbreak source was the wet cooling system of a local factory. Hospital Pulido Valente was one of the hospitals receiving patients with Legionnaires' disease (LD).METHODS: We describe the clinical findings and diagnostic methods used among the 43 confirmed or probable cases admitted to our department.RESULTS: 60.5% were male, mean age was 56.1±13.5 years and tobacco smoking was the most frequent risk factor (76.7%). All patients had fever, 62.8% ≥39.5°C, 72.1% had chills and myalgia/arthralgia and 62.8% had dry cough. Extra pulmonary symptoms were frequent: confusion and headache occurred in 34.9% and gastrointestinal symptoms in 20.9%. High C-Reactive Protein (55.8% ≥30mg/dL) and hyponatremia (62.8%) were the laboratorial abnormalities most commonly found. Hypoxemia occurred in 55.8% and hypocapnia in 93%. Urinary Antigen Test (UAT) was positive in 83.7% of the cases.CONCLUSIONS: Although not specific, a combination of risk factors, symptoms and laboratory findings can be highly suggestive of LD, even in an outbreak. This should prompt diagnosis confirmation. Routine use of UAT in less severe cases of community acquired pneumonia might contribute to earlier diagnosis.

KW - Journal Article

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DO - 10.1016/j.rppnen.2017.01.007

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JO - Revista Portuguesa de Pneumologia

JF - Revista Portuguesa de Pneumologia

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